Guar Gum is disgusting!

Just took my second round of Guar Gum, Rifaximin and Allicin.  Holy crap the guar is so disgusting.  It doesn't have much of a taste it's just really hard to drink gel.  Blech!  I'm up to 1/2 tsp after starting with a 1/4 tsp this morning and having no reaction.  Probably didn't need the guar since I just devoured a burger patty with cheese (first dairy in prob 3 years) and avocado with a huge plate of sweet potato fries.  I usually don't go out to eat but my dad is in town so I decided "F" it, I'm going and I don't care what I eat (within reason).  The additional 7 lbs I'm lugging around these days doesn't make me any more rational!  I tried really hard to stay away from my Array 10 foods but my step-mom was going to let them toss her salmon nuggets so I ate them.  Salmon is a no-no.  Wanted the fish tacos really bad but I'm scared to death of the whole tomato/aquaporin thing and how the heck do you eat a taco without salsa or tomatoes???  (Obviously easy to do at home, harder to improvise in a restaurant and still get the flavor).

Received Biocidin and Olivirex in the mail today, 10 days worth.  I will start them when I run out of Rifaximin.  Ordered Candibactin-BR to add.  I'm too scared to do the AR because of the thyme and gelatin (both positive on Array 10).  I'm probably going to mess around with some essential oils as well.  Try to hit it from every angle possible.  We'll see how it goes!

Bloat

Poor planning led to me to eating too much nuts and chocolate for lunch which of course led to bloating and now itching.  I think I'm going to take the remainder of my Rifaximin (5 days) with guar gum and then switch over to Candibactin AR/BR and take those until they are gone.  Clearly I'm not done yet.

This should be fun.  A friend of mine tried it and ended up puking her guts out.  If you are going to try this, start slow, don't down a full tsp of guar gum the first go around.

Breakfast, 3pm, Bedtime (from Mona Morstein in the SIBO Symposium Clinical Pearls)

1 tsp guar gum in 8 oz of water

Rifaximin

Allicin (I don't have Neomycin and don't want to acquire any)

I'll start this Monday since we are going camping this weekend, likely in rain.  Stay tuned!

Chris Kresser with Dr. Pimental!!

Chris Kresser interviewed Mark Pimental

Talking about the guar gum :)

Clinical Pearls from the SIBO Symposium

The webinars from the SIBO Symposium have finally been released. They are a bit hard to hear but I spent a couple of hours last night listening to the Clinical Pearls section that we missed. Providers had the opportunity to come up and talk about cases and things they are trying or noticing in their patients. They each had 5 minutes. Some takeaways: Farshid Rahbar, MD presented on SIBO and tick borne illness (Lyme). He found that patient with abnormally high levels of hydrogen or methane often had tick borne illness. 65% of people that he has seen that have tick borne disease also have SIBO. Dr. Morstein (ND) uses the generic Rifaximin from Canada and has great success but she always pairs it with 1 tsp of guar gum in 8oz of water. She never treats SIBO without including Lactoprime Plus. She has the client take them with lunch. She felt that if you just treated the SIBO you would end up creating a dysbiosis in the large intestine and then you would be stuck fixing that next. (I have to say I kind of agree, after last summer's war against the archaea I ended up with a bad dysbiosis in my colon.) She also uses Hercius Erineus and Acetyl L-Carnitine to help heal any nerve damage in the small intestine. (My guess is this is the product she uses.) Whitney and Stephanie Hayes, NDs presented on SIBO and infertility. They found if they got rid of a woman's SIBO she often became fertile again. Pretty fascinating since you wouldn't think they would be linked. They think SIBO testing should be considered in any woman with pelvic pain/dysfunctions. Dr. Elena Guggenheim talked about autoimmunity and how the bacteroides seem to modulate the immune response. She presented a case on RA and said that once she got the woman's SIBO under control (only symptom was diarrhea), her RA symptoms greatly reduced and she was able to resume normal activities without daily use of medications. Kelly Reis (sp?), ND was great. She bought her own Quintron so she could get results fast. She also does thermography and finds that people with autoimmune issues have a cooling spot above their T2 thoracic spine. (I had this done before my SIBO diagnosis and I didn't have anything blue (cold) in this area. Fascinating!) She runs a facebook page for clinicians which is a valuable resource since everyone seems to be guessing a bit on the harder cases. Nora Jacoby, ND talked about diet. She has a diet handout that she gives patients and there is access to it for clinicians only on her website www.sibotest.com. She gave no details to say how it was different that the SIBO specific diet. She strongly recommends Dr. Kharrazian's gargle/gag method, breathing exercises and use of cascara sagrada. She also mentioned Heart Math (which I really want), to help you get into rest and digest mode before meals and to help train yourself overall to easily get into parasympathetic mode. Using a Squatty Potty or step stool will help retrain the bowels. If you like local and sustainable (aka expensive) go herehttp://gostool.com/shop/ Dara Perkins, MD has found that with low weight SIBO patients she often has them eat high quality fermented sourdough bread and organic corn products such as polenta for a starch and most have success. One of her patients found that if you combine LDN with antihistamines you may have nightmares. Dr. Ruscio came up and talked about how he tracked patients taking biofilm agents and some who were not and so far hasn't found any difference in effectiveness. He will release his finding later this summer. BIofilm disrupters are a must if the overgrowth is fungal.  He brought up how the microbiota is the next big thing but that a lot of the information going around on blogs is not based in research. He's not ready to jump on the feed the microbiota carb bandwagon. He said prebiotics need to be taken on a case by case basis and you should be gunshy with SIBO patients. He is beginning a study of prokinetics in the next 2-4 months. To be in this study you have to be ending your treatment and SIBO clear when he starts his research. Information at www.drruscio.com Mark Davis, ND talked extensively about FMT and said that even when people swallow (ewwww!) an FMT capsule it does not cause SIBO. He bases this on a study where they sprayed fecal material into the duodenum of people and the bacteria migrated back down to the colon. Allison Siebecker, ND indicated that any kind of self care whether it be acupuncture, massage, yoga, meditation, colonics, deep breathing, etc improves patient outcome. Dr. Moore, ND uses a food allergy test to see if patients have leaky gut, if there are lots of positives or mildly positives it indicates leaky gut. (other NDs mentioned this as well). Expressed need for mentoring program for clinicians treating SIBO (the new GastroANP.org for providers will provide some of this). A doctor asked a question about how to regenerate nerve function in the small intestine. The same herbs were brought up (as above) by Dr. Morstein, acupuncture, colon hydrotherapy, cranial-sacral therapy. Dr. Ruscio brought up again that ICC cells will regenerate on their own once SIBO or antibodies are gone. Steven Sandberg Lewis, ND brought up the whole gut brain connection. He said if there has been any mild traumatic brain injury - former soccer player, non-diagnosed concussion, black eye, broken nose, whiplash (me two or three times), any of those impacts can affect the gut neurology. Neurofeedback is a great way to address it. The general consensus with all the providers was SIBO is either easily treated or very, very difficult. There doesn't seem to be a lot of middle ground. Guess I know where fall!

My notes from SIBO Symposium

I should preface this by saying that on Thursday I received my son's results for the Cyrex Array 3 & 4.  Turns out he was off the charts sensitive to both wheat (interestingly enough the lectins way more than the gluten) and dairy (casein but not whey).  My family loves their bread products and dairy products and they are a staple in our home (I don't eat them of course due to SIBO and dairy sensitivity).  We talked on Thursday evening and Friday morning after they guys left I cleaned all the dairy and wheat out of the house, jumped in the shower and left for the symposium.  Needless to say all this was heavy on my mind during the weekend since I didn't know what the results actually meant in terms of autoimmunity. Our ND can't see us until July.  Thankfully I ran into the Cyrex Rep at the Symposium and she talked me through the results.  Not specific to him or diagnostic but what each value measures, translates to (eg - wheat germ agglutanin is a lectin), and how symptoms may manifest in the body for people.  After talking with her I was able to breathe because I think that Celiacs and IBD are likely off the table. Phew!

Dr. Pimental spoke first about the Underlying Causes of SIBO.  He has teamed up with the military to study IBS because the majority of soldiers get food poisoning on deployment, as if they don't have enough stress!!!  In these studies they have found that 10% of soldiers returning have IBS from one deployment. You can imagine the rates for soldiers going through multiple deployments! They ruled out stress as a cause by asking question such as - did you fire a weapon, did you shoot another human, were you injured, etc. Through these studies he has determined that IBS is not caused by stress (and therefore is NOT all in your head).  His belief is that the majority of SIBO is caused by food poisoning.  Based on a study, 60%+ cases of IBS are caused by SIBO.  They determined this using both duodenal sample and the breath test.  This number is likely low because if the breath test was positive and the sample negative they said negative for SIBO.  Dr. Pimental mentioned that the duodenum is just a small sample of the upper small intestine and often the bacteria is lower down so this percentage is likely low.

Dr. Pimental has done A LOT of work looking at how food poisoning causes SIBO.  He found that when you get food poisoning often from Campylobacter Jejuni, E. Coli, Salmonella or Shigella they can all cause SIBO.  The bacteria produce CDT (Cytolethal Distending Toxin).  The toxin attaches to the wall of the small intestine and the our immune system creates antibodies (Anti-CdtB and Anti-Vinculin), these antibodies go to attack the CDT and in the process destroy the vinculin which in turn damages the Interstitial Cells of Cajal (ICC).  These ICC cells are responsible for motility.  Dr. Pimental found that if you remove CDT from bacteria before injecting it into the mice they still got gastroenteritis but did not get lasting intestinal damage or SIBO.  This is where Dr. Pimental's new test comes in that measures these antibodies. It's his first step in finding a way to cure SIBO. These antibodies - cause SIBO, the greater the antibody the greater the SIBO so can predict treatment length and if we measure antibodies perhaps we can learn how to decrease them and heal the ICC/motility.  Dr. Pimental stated that if you remove the antibodies the body will heal in 3 weeks.  He also said it is imperative for people with SIBO to NEVER get food poisoning again.  He advises some type of antibacterial while traveling with every meal (of course he said Rifaximin but that's only because it's his weapon of choice and he's rumored to get kickbacks, personally I will stick to Biocidin).

Other takeaways from his talk:

• 10 times more people with IBS have an abnormal breath test than normal people.
• Methane slows transit time in the small intestine 69%.
• You are 5 times more likely to get IBS if you have had food poisoning.
• Also, the breath test is not good at measuring methane under 3 so if your hydrogen is elevated and you still have constipation assume it's positive for methane and keep treating.
• If the breath test shows methane in the colon it's still a positive because you shouldn't have methane produced anywhere!
• Stomach acid (and Betaine HCL) slows motility but kills bacteria so take it if you need it!!
• PPIs increase motility but they are NOT recommended because the decrease acid (which kills bacteria)

Dr. Pimental and Dr. Siebecker then presented Elemental Diet Treatment for SIBO.  Dr. Pimental noted that he only has a 50% success rate with methane producers using Vivonex.  Sometimes people don't feel better until 10 days after they stop the elemental diet.  It's important to reintroduce foods SLOWLY, starting out with soups.  Antibiotics don't work during the elemental diet because the bacteria can hibernate.  The elemental diet is effective in 80% of people in 2 weeks, 85% of people in 3 weeks, there is no benefit in going longer.  Thrush can be a side effect of Vivonex due to "all the nutrition being swished in the mouth".  There have been no studies yet on Peptamen but it appears to have the same effectiveness.  Dr. Siebecker has done no formal studies on the homemade formula but she has found virtually the same effectiveness as Vivonex and says she has found it is effective with Methane.  You can find the recipe here.  Can I just say she is so tiny and absolutely adorable?!?!

I skipped Dr. Pimental's presentation on Rifaximin.  Been there, done that, wouldn't do it again, wouldn't recommend it.  I've found herbals much more effective.

Prokinetic Prevention of SIBO presented by Drs. Pimental, Weinstock, Siebecker, Keller.  I didn't take any notes on the prokinetic discussion because I've used most of them :)  The only one I haven't tried is Resolor because it's expensive and you have to get it from Canada.  Dr. Siebecker does a good job outlining prescription options here.  Dr. Pimental likes Resolor the best.  Dr. Weinstock talked about LDN. Dr. Siebecker seems partial to Iberogast (even for kids).  Dr. Keller presented on Motilpro.

Herbals include:

• Iberogast 20 drops with meals and/or at bedtime
• Motilpro - no instructions provided
• Ginger - 1000-1500mg daily

They all seemed to feel that there may not be a benefit to starting prokinetics early.  Often the methane overrides the benefit of the prokinetic and you are just wasting your money.

Steven Sandberg Lewis and Dr. Shaver presented on Beyond the Breath Test: Other tests for SIBO patients.  My takeaway from this was that a provider should never assume it's just IBD, or Celiacs that if the patient doesn't get better they should always check for SIBO (and in some cases vise versa).  Dr. Shaver indicated she likes to r/o celiacs, non-celiac gluten sensitivity, do food sensitivity testing and a stool test.  Celiacs and SIBO often seem to go hand in hand.  Food sensitivity testing helps you identify and remove foods causing symptoms and/or inflammation, stool testing can help identify parasites/pathogenic bacteria/fungus, bacterial imbalance, inflammation, and sIgA ("a key marker of humoral immune status").

Larry Wurn presented on Physical Treatment for SI Obstruction and all I have to say about this is if you feel like surgical scarring/adhesions are an issue for you, you need to check them out.  I have a friend that has been to their clinic and had treatment and it changed her life.  There technique has been well studied and it's no bull!

Sunday was a bit more of a blur.  The conference started at 8am and the presentation was done via video (for an hour and 15 minutes).  It was hard to follow along.  My friend Tim will do a much better job of summing up Dr. Mullin's presentation and I will link it when he does.  Dr. Mullin spoke on a wide variety of topics, one was using D-Limonene 1000g daily as a prokinetic. I don't recall timing but prokinetics are usually at bedtime.  He also talked about use of the Smart Pill to measure PH in various parts of the digestive tract, in addition to measuring motility, pressure and the ICV.  Sound intriguing!  I also wrote down S. Boulardii increases SigA (which is a good thing!).  I think I tossed mine out long ago however so can't add it in now and again.  He spoke about adding in fermented food but I glazed over :(. His uses the garden metaphor, first kill all the weeds (SIBO), support the soil (gut) so good plants can grow, then reseed (pre- and probiotics).  I'm on the probiotics, the prebiotics still scare me a bit!!  Oligosacchararides promote bifido and lacto, discourage growth of clostridia, prevent constipation, etc.  Sounds kind of important.  Oligo's are found in artichoke, asparagus, broccoli, brussel sprouts, fennel, garlic, leek, onion and cabbage. It was interesting, Dr. Mullin seems to be willing to try anything and if I am remembering right he talked about patients ending up in the hospital (one due to use of biofilm buster EDTA) and said "we discontinued use of that treatment" a handful of times. Which is both awesome and frightening.  We need strong SIBO fighters but I'd hate to end up in the hospital!  He has a new book tomorrow!

Dr. Weinstock spoke again about leaky gut and SIBO.  The feeling is that pretty much everyone with SIBO has leaky gut and if your intestinal permeability test comes back negative it's only because the SIBO has eaten all the lactulose/mannitol before it leaked through to the blood and could be measured.  I believe he said they use 10g of lactulose for the breath test and only 5g of lactulose/mannitol for the intestinal permeability test.  Other ways you can look at intestinal permeability is butyrate, lower levels imply impaired barrier, the other ways, measuring LPS (lipopolysaccharide) is difficult, Anti-LPS only shows in acute phases and the endotoxin test requires measurement in the portal vein.  Bottom line, assume intestinal permeability and support repair using the following supplements:

• Serum Bovine Immunoglobin (SBI) - binds and removes microbial components
• Zinc (I use Endozin) - supports tight junctions between cells
• Glutamine - nutrition to support mucosal integrity
• Curcumin - reduces inflammation
• Probiotics - increases zonulin

The Lactulose Breath Test Interpretation was fascinating and we all pulled out our breath tests to follow along.  It went really fast though.  The only takeaway I had was that you want to see a double peak, the dip between peaks indicates that you have moved from the small intestine to the large intestine.  

That pretty much sums it up.  Phew!  Let me know if you have any questions!

Dr. Siebecker video for limited time!!!

Sorry!  I just discovered this in my facebook feed.  Looks likes weeks of really interesting videos!

I that link doesn't get you there, this should.

Breath Test #6

Here is breath test #6.  Finally some good progress.  Numbers are still high but overall everything has decreased which is really awesome.  I did this test after a little over 2 weeks on Rifaximin/Neomycin with Lipophos EDTA as my biofilm buster.  I think Lipophos EDTA works better for me.  I'm back on Klaire Labs Interfase Plus right now but will do a couple of bottles of Lipophos EDTA when I'm done. 

I think the hardest part of the whole process is sticking to the diet when you are not seeing results.  It's such a restricted diet and a real pain to measure everything but in the end, feeling better and having a healthy gut will make it all worth it!

Back on Rifaximin

I didn't really plan this.  I am both a planner and spur of the moment decision person.  Imagine how fun it is to be my spouse!

I ran out of all my herbals at once (Allimed, Neem and Berberine) and I have a TON of Rifaximin and Neomycin (from Canada) so I decided to just use it instead of spending the money to buy more herbals.  I'm not sure how effective they are given they are from India and I didn't have great results last time.  But I'm doing it again.  I did get some Lipophos EDTA because I do like to switch up my biofilm buster.  I usually do Interface Plus.  I really haven't thought about how long I'll stay on the abx but I think I have 5 weeks worth.  Maybe I'll test at 3 or 4 weeks and then decide whether or not I'd like to continue.

I'm also still taking iodine, between 10-12.5 mg per day (4 drops at 2%).  Haven't noticed anything remarkably different.  Will up the dose again in a few days.

Breath Test #4

Let me just say that the tapping has helped me.  I feel much less frustrated and stressed about my diet.  I'm still sticking to it but I'm not so angry about not getting to eat what I want.

Then I got the test results..

WTF!?!?!  So there is many theories and no real answers.  One, the antibiotics from the Canadian pharmacy were inferior.  There is an Alpha and Beta form of Rifaximin and supposedly you want the Beta version.  I haven't seen anything about this anywhere so I'm not sure if it's proven.  There is also a possibility that you can get Rifaximin in the states for much cheaper if you have it compounded.  Second, it's just more bacteria being uncovered and killed off.  It was recommended that I go on the protocol being used at the SIBO clinic at NCNM.  They usually add Berberine in there as well but it was recommended that I hold off on adding it.

• Neem Plus by Ayush Herbs, 2 capsules, 3 times a day
• Interfase Plus, 3 capsule, 2 times a day away from food
• Allimed, 2 capsules, 3 times a day
• Motilpro, 3 capsules, 2 times a day away from food

I'm also still taking the Purge the Whorl and Green Tea Phytosome for the B. hominis.

On the long drive home I decided that it's time to give the Elemental Diet a try if my husband was in agreement.  I'm not keen on additives of any kind so I decided I would do the homemade recipe on Dr. Siebecker's site.  Positives, it less expensive than burning through all these supplements and antibiotics.  Negatives, no food.